Texas Chiropractic eSource

The Texas Chiropractic eSource is your connection to Texas Chiropractic news, updates and events and is emailed to members on a bi-weekly basis.

If there is news that you believe needs to be shared with the profession please send the news, or a link to the news to [email protected]

 
TBCE January 31, 2019 Meeting
Written by Editor   
Tuesday, January 15, 2019 06:46 PM

The Texas Board of Chiropractic Examiners will meet on Thursday, January 31, beginning at 9:00 AM at the William P. Hobby Building at 333 Guadalupe, Tower 2, Room 400A, in Austin.

On the agenda for the meeting are:

  • Approval of the minutes of the Nov. 8, 2018 Meeting.
  • Presentation of the board president’s report.
  • Discussion and possible action regarding election of a board vice president and a secretary/treasurer.
  • Presentation of staff reports.
  • Presentation of board committee reports.
  • Public comment.
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DCs Step Up as Radiation Emergency Screeners
Written by Editor   
Tuesday, January 15, 2019 06:20 PM

It is only a matter of time before a device with real or suspected radioactivity could be employed.  in addition, radiological material is often transported via train or highway, with the potential of an accidental spillage.

Despite the fact that such an occurrence would truly impact a limited number of people, there will be a large segment of the population that will need or wish to be screened for exposure. 

In an ideal response after a radiological “event” of some kind, there should be a designated location for the obviously exposed individuals to gather for evaluation, decontamination and treatment.  There should also be separate locations where those who are concerned, but were not in the immediate vicinity of the incident, can go for screening and education.   DCs in Arkansas have stepped up to help fill this niche.

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Effect of Chiropractic on Reaction Time of Special Operations Forces Military Personnel
Written by Editor   
Tuesday, January 15, 2019 05:53 PM

Chiropractic manipulative therapy (CMT) has been shown to improve reaction time in some clinical studies. Slight changes in reaction time can be critical for military personnel, such as special operation forces (SOF). This trial was conducted to test whether CMT could lead to improved reaction and response time in combat-ready SOF-qualified personnel reporting little or no pain.

This prospective, randomized controlled trial was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY, USA. Active-duty US military participants over the age of 19 years carrying an SOF designation were eligible. Participants were randomly allocated to CMT or wait-list control. One group received four CMT treatments while the other received no treatment within the 2-week trial period. One hundred and seventy-five SOF-qualified personnel were screened for eligibility; 120 participants were enrolled, with 60 randomly allocated to each group. 

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When Medicine Makes People Sicker
Written by Editor   
Tuesday, January 15, 2019 05:42 PM

Since the start of 2013, pharmaceutical companies based in the U.S. or abroad have recalled about 8,000 medicines, comprising billions of tablets, bottles, and vials that have entered the U.S. drug supply and made their way to patients' medicine cabinets, hospital supply closets, and IV drips. The recalls represent a fraction of the medicines shipped each year. But the flawed products contained everything from dangerous bacteria or tiny glass particles to mold -- or too much or too little of the drug's active ingredient.

Over the same period, 65 drug-making facilities recalled nearly 300 products within 12 months of passing a Food and Drug Administration inspection.  Those recalls included nearly 37,000 generic Abilify tablets that were "superpotent," and nearly 12,000 boxes of generic Aleve (naproxen) that were actually ibuprofen, according to the recall data.

Just how often people are sickened or die from tainted drugs is next to impossible to determine. No government agency tracks cases unless they're linked to a major outbreak among hospital patients. And sudden, seemingly random illnesses in disparate places are notoriously hard to link to a tainted drug. That’s in part because drugmakers don't have to divulge which products are made in which manufacturing plants, since that is regarded as proprietary information.  The result: Even someone who buys drugs for a major hospital can’t track down where a potentially dangerous product came from.

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NYC Promises 'Guaranteed' Healthcare for All Residents
Written by Editor   
Tuesday, January 15, 2019 05:22 PM

The city of New York is launching a program to guarantee that every resident has health insurance, as well as timely access to physicians and health services, Mayor Bill de Blasio announced.  "From this moment on in New York City, everyone is guaranteed the right to healthcare -- everyone. We are saying the word 'guarantee' because we can make it happen."  

The program, which will cost $100 million annually, involves several parts. First, officials will work to increase enrollment in MetroPlus, which is New York's public health insurance option. The mayor's office also said the new effort "will improve the quality of the MetroPlus customer experience through improved access to clinical care, mental health services, and wellness rewards for healthy behavior."  The mayor promised that no tax increases are needed to fund the program; the $100 million will come from the city's existing budget, currently about $90 billion.

NYC Care will launch in summer 2019 and will roll out gradually in different parts of the city, starting in the Bronx, according to the release. It will be fully available to all New Yorkers across the city's five boroughs in 2021.

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It’s Party Time – Join Us at TCA Legislative Day, TCLC in Austin
Written by Don White, DC, FICC   
Friday, January 04, 2019 03:25 PM

The holidays are behind us and 2019 is here, but there’s another party or two to attend and I am inviting you as my personal guest.

Valentine’s Day also is TCA Legislative Day, the biggest event of the year for Texas chiropractors. “Show Your Love for Chiropractic!” by joining us in Austin on Thursday, February 14.

Why do you need to be at TCA Legislative Day? The 86th Texas Legislative Session kicks off next week and TCA and all Texas chiropractors have a lot at stake. The threats to chiropractic are as real as they were in 2017, when the Texas Sunset Advisory Commission and Texas Legislature debated your right to diagnose. Guess what? We won and one of the reasons was your passion and commitment to chiropractic.

So, you might be thinking, what’s the next crisis? While the Third Court of Appeals reconsiders last month’s decision in the TMA v. TBCE/TCA lawsuit and we prepare to take our case to the Texas Supreme Court, your ability to treat nerve-related conditions (including the subluxation complex) is at risk. Clearly, the only way to prevent these frivolous lawsuits is to find a legislative solution. Consequently, TCA plans to file a bill that would include the neuromusculoskeletal system within our chiropractic scope.

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TCA Winter Legislative Update
Written by Kaden Norton and Joshua Massingill, StateCraft   
Friday, January 04, 2019 10:43 AM

By: Kaden Norton and Joshua Massingill, StateCraft

The turning of the calendar from 2018 to 2019 means Texas’ 86th Legislative Session is nearly here! Next week, legislators from across the state will descend upon Austin to address the issues facing Texas and Texans. Just as the New Year brings a sense of hope and opportunity for each of us, so too does the upcoming session for Texas chiropractors.  

Texas’ 86th Legislative Session begins on January 8 and continues for 140 days until May 27. In the Texas House of Representatives, the members’ first action will be to elect a new Speaker (due to past-Speaker Joe Straus’ retirement). Rep. Dennis Bonnen (R-Angleton) has secured the necessary votes to become the next Speaker. During the first few weeks of the session, the newly-elected Speaker and the Lieutenant Governor will appoint representatives and senators, respectively, to various committees on topics such as transportation, education, criminal justice and healthcare. Once these committee assignments are made, legislative committees will begin holding hearings to consider legislation. To reach the Governor’s desk, a bill must win the approval of both a House and Senate committee and then receive a favorable vote from the full House and Senate. Historically, only 20-25% of filed bills survive the lengthy and difficult process to become law. 

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Nominate a Colleague for an Award
Written by Editor   
Tuesday, January 01, 2019 12:00 AM

The deadline for nominations for the Keeler Plaque and the Young Chiropractor of the year is rapidly approaching.

Make your nomination by May 17!

To nominate, just legibly write or type your nomination and mail it to the Texas Chiropractic Association at 1122 Colorado, Suite 307, Austin TX 78701.  Make sure to put “Keeler” or “Young Chiro” on the envelope and it will be distributed to the appropriate committee unopened.

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Dec. 2018 TBCE Report
Written by Editor   
Monday, December 31, 2018 05:41 PM

In their December 2018 Newsletter the Texas Board of Chiropractic Examiners reports that there are 5,837 active DC licenses.  There are 49 CE-conditional licenses and 261 expired licenses.  702 licenses are inactive status, and 19 have a probated or suspended license.

Disciplinary actions reported in this newsletter included:

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NBCE: New District IV Director
Written by Editor   
Monday, December 31, 2018 05:37 PM

The National Board of Chiropractic Examiners recently announced the election of Dr. Cynthia L. Tays of Austin, Texas, as District IV Director. District IV includes the states of Arizona, California, Colorado, Hawaii, Kansas, Nevada, New Mexico, Oklahoma, Texas, and Utah.

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Affordable Care Act Struck Down by Texas Judge
Written by Editor   
Monday, December 31, 2018 05:13 PM

A federal judge ruled that the Affordable Care Act is unconstitutional.  

It argues that because the tax reform bill passed by Congress -- the Tax Cuts and Jobs Act (TCJA) of 2017 -- gets rid of the ACA's "individual mandate" penalty for not having health insurance, the requirement for individuals to have health insurance is void, and because of that, the rest of the law should be invalidated.

Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas agreed with the plaintiffs.  He reasoned that "the Supreme Court held the individual mandate was unconstitutional under the Interstate Commerce Clause but could fairly be read as an exercise of Congress's tax power because it triggered a tax.  "The TCJA eliminated that tax. The Supreme Court's reasoning in NFIB ... thus compels the conclusion that the individual mandate may no longer be upheld under the tax power. And because the individual mandate continues to mandate the purchase of health insurance, it remains unsustainable under the Interstate Commerce Clause -- as the Supreme Court already held."

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Study Shows Opioids Offer Little Chronic Pain Benefit
Written by Editor   
Thursday, December 27, 2018 06:21 PM

Is the use of opioids to treat chronic noncancer pain associated with greater benefits or harms compared with placebo and alternative analgesics?  A new analysis again demonstrates opioids may provide benefit for chronic noncancer pain, but the magnitude is likely to be small.

Pain creates a quality of life issue that opioids have utterly failed to address. Where should patients turn instead to treat and manage chronic pain conditions? Research released recently stated that patients undergoing chiropractic maintenance care had less back pain days than those not receiving chiropractic maintenance care. 

The “Triple Aim” in modern healthcare requires patient satisfaction, low costs and effective treatment. Chiropractic care has high marks in all these areas, yet physicians and private insurers continue to opt for low value, ineffective care – like opioids –  that carry devastating consequences for patients and their families.

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TCA Announces Continued Relationship with Tax Favored Benefits, Official Retirement Plan Provider of TCA
Written by Editor   
Thursday, December 20, 2018 11:32 AM

The Texas Chiropractic Association (TCA) is pleased to announce the renewal of its partnership with Tax Favored Benefits (TFB), the official retirement plan provider of TCA.

TCA encourages the chiropractic community to consider TFB for their personal and business’ retirement planning needs. TFB helps clients by designing strategies to efficiently implement financial planning goals. TCA entrusts their retirement and financial planning to the expertise of TFB.

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ACA's NCLC Becomes "ACA Engage"
Written by Editor   
Friday, December 14, 2018 12:12 PM

The American Chiropractic Association (ACA) has announced plans to rename its annual meeting “ACA Engage” beginning in 2020. The new name is part of the association’s ongoing efforts to position members for success by bringing them cutting-edge education, networking and leadership-development opportunities, and the chance to lobby Congress on behalf of their patients and the profession. 

The National Chiropractic Leadership Conference (NCLC) has long been known for bringing together industry leaders from all over the country to meet with members of Congress on Capitol Hill, and engaging legislators will always be a priority. Over the past several years, however, the program has expanded considerably to include a wide variety of education offerings (with CE credit available), speeches from respected thought leaders and panel discussions that delve into some of the profession’s most compelling and important topics. The new name better reflects the expanded focus of the conference.

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TCA Motion for Reconsideration Filed in VONT Case
Written by Editor   
Thursday, December 13, 2018 10:15 AM

On Wednesday, December 12, TCA filed a motion for reconsideration with the Third Court of Appeals in Austin in the TMA vs. TBCE/TCA (VONT) appeal. In its decision, the Court struck down the Texas Board of Chiropractic Examiners’ definition of the subluxation complex, faulting TBCE for calling it “a neuromusculoskeletal condition.” However, TCA believes the Court did not analyze whether “subluxation complex” – a freestanding part of the Texas Chiropractic Act – might include some element of nerves. TCA also contends that TBCE’s definition is the only correct definition of the subluxation complex and that it accurately reflects the core concept of chiropractic. TCA believes the Court should have separately analyzed the term “subluxation complex” instead of lumping it together with “musculoskeletal system” and that the subluxation complex—even with a role for nerves—is not the practice of neurology.

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Attacking Running Pain, You Begin at the body’s foundation.
Written by Tim Maggs, DC   
Wednesday, December 12, 2018 01:25 PM

Running coach Eric Orton said, “The health of our feet truly dictates the health of our running ability.” Many running injuries stem from weak foot muscles or imbalances in the feet that are invisible to the naked eye. Plantar Fasciitis, Achilles Tendinitis, iliotibial band syndrome, patellofemoral pain syndrome, medial tibial stress syndrome, and metatarsalgia are injuries runners suffer from. Some estimates put the number of runners who are sidelined by these injuries annually at 90 percent. 

A 2015 study published in the British Journal of Sports Medicine found that runners who avoid injury land lightest on their feet, reducing the force of impact. Researchers suggest that runners consciously think about landing more softly and adjust their stride to land closer to the midfoot. This is easier said than done. Most runners are heel-strikers, and there are some indications that runners with excessive pronation or high arches, who attempt to transition to a forefoot strike pattern, might be more susceptible to injury.  

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Chiropractic Integration into Multidisciplinary Rehabilitation: A Descriptive Study
Written by Editor   
Tuesday, December 11, 2018 07:04 PM

Individuals rehabilitating from complex neurological injury require a multidisciplinary approach, which typically does not include chiropractic care. This study describes inpatients receiving multidisciplinary rehabilitation including chiropractic care for brain injury, spinal cord injury (SCI), stroke, and other complex neurological conditions.

Chiropractic services were integrated into a 62-bed subacute multidisciplinary rehabilitation, skilled nursing facility through this project. Patient characteristics and chiropractic care data were collected to describe those receiving care and the interventions during the first 15 months when chiropractic services were available.

Brain injury was the most common admitting condition caused by trauma, hemorrhage, infarction, and general anoxia. Three patients were admitted for cervical SCI, one for ankylosing spondylitis, one for traumatic polyarthropathy, and two for respiratory failure with encephalopathy. 

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Chiropractic Integration into Multidisciplinary Rehabilitation: Stakeholder Expectations
Written by Editor   
Tuesday, December 11, 2018 06:56 PM

Few studies have investigated patient and provider expectations of chiropractic care, particularly in multidisciplinary settings. This qualitative study explored stakeholder expectations of adding a chiropractor to the healthcare team at a rehabilitation specialty hospital.  

In this study sixty stakeholders, including patients, families, hospital staff, and administrators, were interviewed or participated in focus groups. Expectations for the chiropractic program were mostly positive with themes consistently reported across stakeholder groups.

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Chiropractic in Interdisciplinary Rehab: a Case Report
Written by Editor   
Tuesday, December 11, 2018 06:49 PM

Approximately 70% of patients suffering from spinal cord injury (SCI) experience persistent pain, which can substantially influence cognition, emotional status, activities of daily living, and quality of life. Musculoskeletal pain is commonly experienced in both acute and chronic postinjury phases and pharmacotherapy is often an insufficient pain management strategy.  Rehabilitative care for patients with SCI requires multi-specialty coordination to address the common presence of multiple overlapping conditions.

This case report describes interdisciplinary rehabilitation, including chiropractic, for a 51-year-old male recovering from incomplete cervical SCI and multiple comorbidities following an automobile accident.

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VONT Case: Even Though...
Written by Chris G Dalrymple, DC, FICC   
Tuesday, December 11, 2018 05:38 PM

On November 21, 2018, the Third District Court of Appeals in Austin issued a ruling in the appeal of the “VONT case.”   “We have overruled appellants’ issues related to the Rule’s references to nerves and its provision related to VONT. We have sustained their issues related to the Rule’s use of the word ‘diagnosis.’ … we affirm the remaining portions of the court’s judgment.

Even though the founder of Chiropractic, D.D. Palmer, before the 1900s,  stated:

“I founded Chiropractic on Osteology, Neurology, and Functions—bones, nerves and the manifestations of impulses”

even though it appears that the first Doctor of Chiropractic in Texas who had studied and graduated from D. D. Palmer’s School of Chiropractic in 1898 authored the medical text Osteopathy Illustrated; Neurology; Neuropathy; even though the earliest advertisments of doctors of chiropractic included the claim that they were “nerve specialists”, the court has seen fit to exclude nerves from the purview of chiropractic.

Even though the court notes that:

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VONT Case: The History
Written by Chris G. Dalrymple, DC, FICC   
Tuesday, December 11, 2018 04:53 PM

Recent History

On November 21, 2018, the Third District Court of Appeals in Austin issued a ruling in the appeal of the “VONT case”, stating 

we have overruled appellants’ issues related to the Rule’s references to nerves and its provision related to VONT. We have sustained their issues related to the Rule’s use of the word 'diagnosis.' We therefore reverse the trial court’s judgment as far as it declares that the use of 'diagnosis' in section 78.13(d) exceeds the scope of chiropractic practice and is void. We affirm the remaining portions of the court’s judgment,” 

This refers to the portion of the rules:

  • allowing certain chiropractors to perform VONT,
  • the definition of ‘musculoskeletal system’ as including the nerves; and
  • the definition of "subluxation complex" as a "neuromusculoskeletal condition". 
Read more...
 
Texas House Select Committee Publishes Report on Opioids and Substance Abuse
Written by Editor   
Tuesday, December 11, 2018 01:08 PM

The substance abuse crisis in our nation and state prompted the Texas House of Representatives’ Speaker Joe Straus to appoint the Select Committee on Opioids and Substance Abuse (Committee).  The House Select Committee on Opioids and Substance Abuse was tasked by the Speaker of the House to “develop and present concrete principles and action items to reduce the scourge of opioids in Texas and to provide legislative solutions to address these issues, as well as examine other topics related to substance abuse in Texas.”

Rep. Four Price, the chair of the committee notes that the committee "conducted six robust hearings with over 70 invited expert witness testimonies.This led to the committee producing a detailed report outlining the current challenges, including recommendations that can make a positive impact if enacted by the Texas Legislature.”  TCA Scientific Affairs Department Coordinator, Dr. Craig Benton presented testimony at one of these hearings.

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Groups Call on Congress to End Surprise Billing
Written by Editor   
Tuesday, December 11, 2018 12:08 PM

Nine groups representing health insurers, employers and consumers have called for federal legislation to protect patients from surprise medical bills from out-of-network providers.

Surprise medical bills may arise when a patient unintentionally visits a doctor or healthcare facility that does not contract with the patient's health insurer. Surprise billing is common, with 4 in 10 insured adults reporting they received a surprise medical bill in the last year.

The groups—which include powerful lobbyists like the Blue Cross and Blue Shield Association, America's Health Insurance Plans, the National Business Group on Health, and Consumers Union—called on Congress to prohibit providers from billing patients for costs not covered by the health plan when the out-of-network visit isn't the patient's fault.But they also said Congress should ensure any policy enacted doesn't increase premiums or discourage providers from joining a health plan's network.

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Hot Topic: RTX
Written by Editor   
Tuesday, December 11, 2018 11:54 AM

Resiniferatoxin (RTX) is a hot topic among those looking for opioid alternatives. How hot? It scores 16 billion units on the Scoville scale that measures the hotness of peppers and spicy food. That makes RTX 10,000 times hotter than the hottest known pepper, the Carolina reaper. 

Found in a species of the spurge flowering plants native to Morocco known as Euphorbia resinifera or resin spurge.  It occurs on the slopes of the Atlas Mountains.  RTX is not only fiery, it's accurate. It can target and destroy nerve endings for pain, and for pain only.  Unlike opiates, the chemical only attaches to a pain-sensing molecule called TRPV1. This means, if you have a pain in your toe, RTX wouldn’t numb your entire foot.  RTX directly interacts with afferent nerve cells without affecting other sensations such as touch, pressure. It is currently the most potent TRPV1 agonist known.  The dried latex of the plant has been used as ancient medicine since at least its first written record from the time of Roman Emperor Augustus.

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ACA Publishes Diversity Statement
Written by Editor   
Tuesday, December 11, 2018 08:01 AM

The American Chiropractic Association (ACA) has published a statement on diversity that acknowledges the importance that cultural competency plays in the chiropractic profession’s ability to deliver quality health care, improve patient outcomes and engage in public health initiatives.

“ACA acknowledges cultural agility as a foundation for competent healthcare delivery to improve patient outcomes and engage in public health initiatives,” the statement reads in part. “ACA defines cultural agility as having enhanced skills and knowledge of the needs of a multicultural society and requiring a commitment to inclusion that begins with broader concepts of diversity.”

In its statement, ACA also notes that diversity encompasses, “without limitation, race, color, ethnicity, gender, sexual orientation, gender identity and expression, religion, nationality, age, disability, socioeconomic status and marital and parental status.”

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Be Aware: Acute Flaccid Myelitis
Written by Editor   
Monday, December 10, 2018 06:58 PM

Acute flaccid myelitis (AFM) is a very rare condition that affects a person’s spinal cord marked by the sudden onset of weakness in the arms or legs. 

AFM can be difficult to diagnose because it shares symptoms with several other neurologic conditions. All suspected cases of AFM are reviewed by the CDC to determine if they meet the case definition. It can take about a month for the status of a case to be determined. CDC data shows a pattern of increased AFM cases in late summer to early fall of every other year beginning in August 2014. Texas providers have reported 46 cases of AFM since 2014. Most of the cases occur in children.

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Introduced Legislation: HB 455, 460, 461
Written by Editor   
Sunday, December 09, 2018 08:44 PM

Some legislative bills are already being filed for the upcoming legislative session.  We will begin to report here on bills that may touch upon the chiropractic profession.

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TBCE Proposes Continuing Education Change
Written by Editor   
Sunday, December 09, 2018 06:53 PM

The Texas Board of Chiropractic Examiners (Board) proposes repealing Rule 73.1 (Continuing Education) and to replace it at the same time with an updated new rule regarding continuing education.

While much of the rule remains similar to its previous version, the new proposal now adds two definitions that are applied to “continuing education.”  

The first defines “live-format” courses as ”any educational course that is not pre-recorded and is presented in real time through an interactive medium such as a live webinar or at an in-person training event.”  

The second defines an “online course” as “any pre-recorded or live format educational course that is delivered through an internet-based platform. All online courses shall have the means to verify attendance through testing on the material presented or other approved format.”

And now, while  “the 16 hours of continuing education may be completed through any course or seminar elected by the licensee that has been approved by the Board,” another change is that “a licensee must attend any course designated as a ‘TBCE Required Course’ in a live format, and the course may be counted as part of the 16 hour requirement."

The new proposal would also limit licensees to “up to ten hours of online courses that are not live format."

The newly proposed Rule §73.1, Continuing Education reads:

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ANNOUNCING: Call for Nominations to 2019-20 TCA Executive Offices
Written by Editor   
Monday, September 10, 2018 10:45 AM

Early next year the Texas Chiropractic Association will elect executive officers for 2019-20.  The association is calling for nominations of those interested in pursuing service as an executive officer.  The executive officers of the TCA are the president, vice president and secretary/treasurer.  They are elected for a one-year term of office or until their successors are elected and installed.  

Candidates for election must maintain a license to practice chiropractic in Texas and be a regular TCA member in good standing for the five years prior to election.   They must have served a full term as state director, association committee chair, district president, or department coordinator.

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